In his article "Some Moderate Alcoholics Can Just Cut Back" Second Opinion, Nov. 27 , John McFadden claims that some alcoholics can return to drinking in "moderation." Many of us in the alcoholism community feel that this assertion is damaging to the individual suffering from the disease of alcoholism, and to his or her family.
I liken McFadden's article to yelling "fire" in a crowded building. The first question which comes to mind is, "What is the recovering alcoholic supposed to believe when he reads this?" It has significant potential for causing great harm and even death to alcoholic persons.
For example, I learned from Dr. William Flynn, director of Alcohol and Drug Services at Georgetown Medical Center, that "just this week, the hospital admitted a patient who had a number of years of sobriety, then read the article and began thinking about what it said, and ultimately began to try 'controlled drinking.' In being hospitalized, he now feels that he has done research on 'controlled drinking' the hard way."
Although "abstinence" may be the unpopular view, it's the majority view in the alcohol treatment community.
McFadden's statements should be rebuked on several different levels. In a discussion of "alcoholism," he should have provided a definition at the outset. The American Medical Association (AMA) defines it as: "An illness characterized by significant impairment that is directly associated with persistent and excessive use of alcohol. Impairment may involve psychological, physiological or social dysfunction." The AMA also states that alcoholism "ordinarily interferes seriously with the patient's mental and physical health and his adaption to his environment." The National Institute on Alcohol Abuse and Alcoholism (NIAAA) says alcoholism is a physical addiction characterized by chronicity, increasing tolerance and withdrawal symptoms when drinking ceases. It also specifies that alcoholics cannot return to drinking.
The article also fails to define or put boundaries on what McFadden calls "controlled drinking" or drinking in "moderation." Futhermore, he does not list any criteria for identifying an alcoholic who can return to "moderate" drinking.
McFadden also makes some misleading statements. "When the disease theory of alcoholism was first introduced 30 years ago," he states, "it appeared to offer relief from the then-prevailing attitude that alcoholism was the result of moral weakness and that moralistic pressure was the only valid response." By drawing an inference linking morality and abstinence, the reader may conclude that advocates of abstinence place rigid, authoritative and moralistic pressure on drinkers. I have found that most alcoholism counselors who advocate abstinence are warm, compassionate people. Alcoholism is a disease, and recovery, as we are told by recovering alcoholics themselves, only comes with abstinence. Similarly, you don't tell a smoker with emphysema or lung cancer that he can have one pack of cigarettes a day instead of two.
The article also misrepresents employe assistance programs (EAPs), which are work-based programs designed to help restore performance-impaired employes to health. EAPs enable early identification and referral for employe/alcoholics in a stigma-free, confidential environment. EAP counselors, after assessing the problem, offer the best appropriate options, which may include referral to self-help groups, education programs and professional treatment.
McFadden says, "Professionals in such abstinence programs believe that coercion is sometimes necessary to save the most afflicted alcoholics from imminent dismissal." Generally, workers who are referred by their supervisors to EAPs are already in danger of losing their jobs because of poor work performance. The "coercion" discussed by McFadden is a suggestion from the supervisor that employes can seek appropriate help through the EAP. Moreover, the employe is offered the option of a confidential visit to the EAP voluntarily, and may even refer himself without the supervisor's knowledge or involvement. If the employe's job performance continues to deteriorate, he can be dismissed by the supervisor, as would any other employe with poor work performance.
Another point McFadden makes is: "This coercive approach contrasts with the methods of the best psychological treatments, which use collaboration. Relations are confidential and depend entirely on trust and mutual respect." Alcoholism is a disease of denial. Alcoholics will often compromise almost every aspect of their lives, such as religion and family, in favor of continued drinking. The reason EAPs are effective in helping alcoholics is that the threat of job loss is what often makes the alcoholic realize his problem and seek confidential help. There is a stigma which accompanies alcoholism -- people often don't think of alcoholics as employed individuals, and if you interfere at his job, constructive action occurs.
The heart of the matter is that abstinence advocates endorse a "tough love" approach to recovery. Most alcoholics seeking treatment have already tried "controlled drinking" on their own. It would certainly be a lot easier for a counselor to place an alcoholic on a "controlled drinking" program, but we believe that in most cases the results would be devastating. Despite McFadden's claims, the bulk of the research findings is clearly weighted toward abstinence. Even though abstinence is a difficult notion to accept for active alcoholics, it has proved itself the most effective.